NPIMap

Individual provider Active NPI

Justin M McInnis, MD

  • Family Medicine Physician
  • Jacksonville, TX
National Provider Identifier
1801002837
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N0262 Issued in TX
Practice address
203 Nacogdoches St Ste 280
Jacksonville, TX 75766-2444
Phone
(903) 541-5390
Fax
(903) 541-5393
NPI assigned
May 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N0262 TX Primary

Addresses

Primary practice location

203 Nacogdoches St Ste 280
Jacksonville, TX 75766-2444

Mailing address

203 Nacogdoches St Ste 280
Jacksonville, TX 75766-2444
Phone (903) 541-5390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080618000593 TX Practitioner - Family PracticePractitioner - General Practice 2365513330 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical Branch at Galveston, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ault McInnis PLLCGroup PAC ID 9133396674, 7 clinicians

Practice addresses (Care Compare)

2114 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 284-6105

Hospital & facility affiliations

  • Vitalcaring Group Home health agency, Henderson, TX, CCN 458072
  • Enhabit Home Health Home health agency, Palestine, TX, CCN 678197
  • Paradigm Homecare Home health agency, Tyler, TX, CCN 457833
  • Ut Health East Texas Home Health Services Home health agency, Athens, TX, CCN 677586
  • Christus Mother Frances Hospital- Jacksonville Hospital, Jacksonville, TX, CCN 451319
  • Ut Health East Texas Jacksonville Hospital Hospital, Jacksonville, TX, CCN 450194
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • University of Texas Health Science Center at Tyler Hospital, Tyler, TX, CCN 450690
  • Ut Health East Texas Rehabilitation Hospital Inpatient rehabilitation facility, Tyler, TX, CCN 453072

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TEMPORARYTXMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family First Urgent Care PLLC CurrentSince Oct 15, 2013 Accepting new patients
Ault McInnis PLLC Family Medicine CurrentSince Oct 25, 2011 Accepting new patients
Complete Emergency Care Tyler LLC Past Accepting new patients

Locations

2114 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

2116 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

Interoperability endpoints

  • Direct secure messaging: justinmcinnis@ffoj.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ault McInnis PLLCJacksonville, TX, CCN 678936 Rural health clinic Contracted Managing Employee
5% Or Greater Indirect Ownership Interest (50%)		 Nov 17, 2011
Nov 17, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Ault McInnis PLLC
    • Family Medicine Physician
    • Jacksonville, TX
    • NPI 1942587159

    5% Or Greater Indirect Ownership Interest, Contracted Managing Employee

    CMS ownership

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1801002837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 NACOGDOCHES ST STE 280",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662444",
            "telephone_number": "903-541-5390",
            "fax_number": "903-541-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 NACOGDOCHES ST STE 280",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662444",
            "telephone_number": "903-541-5390",
            "fax_number": "903-541-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINNIS",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, TX

Sources for this page

Verify at the official NPI Registry.